Scaling up a tobacco control intervention in low resource settings: a case example for school teachers in India.

Research on processes of bringing effective tobacco control interventions to scale to increase quit rates among tobacco users is uncommon. This study examines processes to bring to scale one such intervention for school teachers, i.e. Tobacco Free Teacher-Tobacco Free Society (TFT-TFS). This intervention provides a foundation for an effective and low cost approach to promote cessation through schools. The present study was conducted in the states of Bihar and Maharashtra in 2014 using quantitative and qualitative methods. Focus group discussions (FGDs) were analysed using immersion crystallization method. The data presented are from a survey of 291 principals and seven FGDs. This study examined characteristics of principals and teachers, organizational environment, external environmental factors and program characteristics to determine facilitators and barriers for successful dissemination and implementation of the TFT-TFS program. Some facilitators were, incorporation of the program in existing channels like staff meetings and trainings, certification and recognition by the department of education; while some barriers were routine time bound duties (mainly teaching) of teachers and prevalence of tobacco use among teachers and administrators. Principals and teachers expressed a need and high level of interest in the adoption and implementation of the TFT-TFS program in their schools.

The relation between price and daily consumption of cigarettes and bidis: findings from the Tobacco Control Policy Evaluation Wave 1 Survey.

CONTEXT: In India, 14% of the population use smoked tobacco products. Increasing prices of these products is one of the measures to curb their consumption. AIMS: This study analyzes "unit price" and "daily consumption" of cigarettes and bidis and investigates their relation with each other. SETTINGS AND DESIGN: A cross-sectional survey was conducted in four states of India (Bihar, West Bengal, Madhya Pradesh and Maharashtra) as a part of the International Tobacco Control Policy (TCP) Evaluation Project (the TCP India Project) during 2010-2011. METHODS: Information was collected from adult (aged ≥ 15) daily exclusive smokers of cigarette/bidi regarding (a) last purchase (purchase in pack/loose, brand and price) and (b) daily consumption. Average unit price and daily consumption was calculated for different brands and states. Regression model was used to assess the impact of price on daily consumption. RESULTS: Bidis were much less expensive ([symbol in text]0.39) than cigarettes ([symbol in text]3.1). The daily consumption was higher (14) among bidi smokers than cigarette smokers (8). The prices and daily consumption of bidis ([symbol in text]0.33-0.43; 12-15) and cigarettes ([symbol in text]2.9-3.6; 5-9) varied across the four states. The unit prices of bidis and cigarettes did not influence their daily consumption. Smokers purchasing bidis in packs paid substantially less per unit and purchase of bidis and cigarettes in packs influenced their consumption positively. CONCLUSIONS: Cigarettes although more expensive than bidis, seem very cheap if compared internationally. Hence, prices of both cigarettes and bidis do not influence their consumption.

Intention to quit among Indian tobacco users: findings from International Tobacco Control Policy evaluation India pilot survey.

INTRODUCTION: Tobacco users face barriers not just in quitting, but also in thinking about quitting. The aim of this study was to understand factors encouraging intention to quit from the 2006 International Tobacco Control Policy (TCP) Evaluation India Pilot Study Survey. MATERIALS AND METHODS: A total of 764 adult respondents from urban and rural areas of Maharashtra and Bihar were surveyed through face-to-face individual interviews, with a house-to-house approach. Dependent variable was "intention to quit tobacco." Independent variables were demographic variables, peer influence, damage perception, receiving advice to quit, and referral to cessation services by healthcare professionals and exposure to anti-tobacco messages. Logistic regression model was used with odds ratio adjusted for location, age, gender, and marital status for statistical analysis. RESULTS: Of 493 tobacco users, 32.5% intended to quit. More numbers of users who were unaware about their friends' tobacco use intended to quit compared to those who were aware (adjusted OR = 8.06, 95% CI = 4.58-14.19). Higher numbers of users who felt tobacco has damaged their health intended to quit compared to those who did not feel that way (adjusted OR = 5.62, 95% CI = 3.53-8.96). More numbers of users exposed to anti-tobacco messages in newspapers/magazines (adjusted OR = 1.76, 95% CI = 1.02-3.03), restaurants (adjusted OR = 2.47, 95% CI = 1.37-4.46), radio (adjusted OR=4.84, 95% CI = 3.01-7.78), cinema halls (adjusted OR = 9.22, 95% CI = 5.31-15.75), and public transportation (adjusted OR = 10.58, 95% = 5.90-18.98) intended to quit compared to unexposed users. CONCLUSION: Anti-tobacco messages have positive influence on user's intentions to quit.

Social disparities in tobacco use in India: the roles of occupation, education and gender.

BACKGROUND: Identifying social disparities in patterns of tobacco use with regard to education, occupation, and gender characteristics can provide valuable insights into the tobacco use patterns of the population. AIM: We assessed social disparities in tobacco use, smoking, and smokeless tobacco use by examining occupation-, education-, and gender-specific patterns. SETTING: About 69,030 Indian residents ≥15 years in 29 States and 2 Union Territories (UT). DESIGN: Three-stage sampling in urban areas and two-stage sampling in rural areas for selection of households. MATERIALS AND METHODS: Data has been derived from GATS 2009-2010, wherein the sample was collected through household interviews. STATISTICAL ANALYSIS: Percentages, proportions, adjusted odds ratios (ORs), and 95% confidence interval (CI) were reported. RESULTS: As a person entered adulthood, the prevalence of ever tobacco use increased by 51.5% among men and 28.8% among women. Prevalence was 2.5 times higher in men (mainly smoking) as compared to women (predominantly smokeless form). ORs for tobacco use were higher among illiterate respondents as compared to the college educated (male OR = 4.23, female OR = 8.15). Unemployed, able to work (male OR = 1.50, female OR = 1.23) showed highest risk, while students (male OR = 0.35, female OR = 0.52) showed the least. The combined effect of occupation and education showed synergistic interaction among females and antagonistic interaction among males. CONCLUSION: The study clearly underscores the individual and joint effects of education and occupation on tobacco use besides discussing variations based on gender. This can have far-reaching policy implications in addressing disparities in tobacco use.

Tobacco industry interference for pictorial warnings.

AIM: A study was carried out to understand the process of interference by the tobacco industry, to measure the compliance of the industry for displaying pictorial warnings on a tobacco product as per the packaging and labeling rules post 31st May, 2009, and to understand the public opinion on the messages conveyed through such warnings. MATERIALS AND METHODS: A total of 60 samples of tobacco products were purchased after 31 May, 2009, from the retail vendors of tobacco sellers across the country. RESULTS: The government of India has from time to time, taken measures, including legislations, to control tobacco consumption. The actual implementation of these rules has been postponed repeatedly, apparently because of constant pressure exerted by the tobacco industry. The skull and bone sign hurting religious sentiments as stated by the group of ministers proved to be misleading. Later the Group of Ministers (GOM) proposed three very weak and poorly communicative pictorial health warnings to replace those recommended by the Union Health Ministry based on the inputs of the Department of Audio Visual Publicity (DAVP). The industry tried to use strategic means by displaying a dull, diluted, and watered down pictorial warning. The focus group study conducted showed that a scorpion gets associated with the product in a non-scientific manner. X-ray of the lung was hardly understood by anybody. CONCLUSION: Overall the tobacco industry has constantly flouted with the law right from the policy level to its implementation by displaying dull, diluted, and poorly informed pictorial warnings.